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Assistant Professor of Dermatology, Department of Dermatology, University of Catania, Catania, Italy
Professor of Dermatology, Department of Dermatology, University of Catania
Clinical Assistant Professor, College of Pharmacy, University of Illinois, Chicago, IL
Clinical Pharmacist, Department of Dermatology, Northwestern Medical Faculty Foundation, Chicago
Professor of Dermatology, Department of Dermatology, Northwestern University, Feinberg School of Medicine; Professor of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago
Reprints: Dennis P West PhD FCCP, Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 19-150, 675 N. St. Clair St., Chicago, IL 60611-2923, FAX 312/695-4431, dwest{at}northwestern.edu
OBJECTIVE: To review published data on thalidomide, with emphasis on current knowledge about mechanism of action, new and/or potential dermatologic and nondermatologic therapeutic applications, well-known and emerging adverse effects, and current indications for its safe use.
DATA SOURCES: Review articles, in vitro research studies, references from retrieved articles, case reports, and clinical trials were identified from a computerized literature search using MEDLINE and OVID (1966–January 2003) and on the Cochrane Clinical Trials Register (January 2003). Information available from meetings' abstract books, Internet, or pharmaceutical companies was also considered.
STUDY SELECTION AND DATA EXTRACTION: All articles identified as relevant, including those from non-English literature, were considered in an attempt to provide to the reader both the theoretical basis and practical guidelines for thalidomide pharmacotherapy.
DATA SYNTHESIS: Thalidomide has hypnosedative,
antiangiogenic, antiinflammatory, and immunomodulatory properties. Moreover,
it has been shown to selectively inhibit the production of tumor necrosis
factor-
and reduce the expression of various integrin receptors on the
membrane of leukocytes and other cell types in a dose-dependent fashion.
Controlled trials demonstrated the efficacy of thalidomide in a number of
diseases, including erythema nodosum leprosum, lupus erythematosus, aphthosis,
graft-versus-host disease, prurigo nodularis, and actinic prurigo. Single case
reports or studies in small series have also suggested a possible role for
thalidomide in numerous other dermatologic and nondermatologic disorders.
Possibly severe and sometimes irreversible risks related to the clinical use
of thalidomide include teratogenicity and neurotoxicity.
CONCLUSIONS: Although teratogenicity and neurotoxicity are significant adverse effects requiring cautious use, thalidomide is an effective therapeutic modality in a variety of difficult-to-treat disorders and, providing careful selection of patients, should offer an acceptable risk-to-benefit ratio.
Key Words: dermatologic disorders, thalidomide
Published Online, July 25, 2003. www.theannals.com, DOI 10.1345/aph.19255
THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE
UNIVERSAL PROGRAM NUMBER: 407-000-03-027-H01
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